Emma McBride (Dobell, Australian Labor Party, Shadow Assistant Minister for Mental Health) Share this | Hansard source

I rise to speak on the National Health Amendment (Safety Net Thresholds) Bill 2019. Labor will support this bill which will reduce the PBS safety net thresholds from 1 January 2020. Labor matched the government's commitment to do so during the election campaign. That's what political parties should do—recognise and adopt good ideas from the other side. We urge the government to do the same with the health policies we took to the recent election.

I first registered as a pharmacist in 1998, so I have a longstanding interest in the Pharmaceutical Benefits Scheme. At that time, the PBS co-payment for a concession patient was $3.20 and it was $20 for general patients. But I'd like to go back a bit further and take a quick step back through the history of medicine access in Australia, because it matters. In 1919, with sick and wounded Australian service men and women returning from the Boer War and World War I, a program was necessary to provide veterans with access to life-saving medicines, and the Repatriation Pharmaceutical Benefits Scheme was established.

In 1944, a High Court challenge struck down the first attempt made by a federal government to legislate for a scheme to expand access to approved prescription medicines, such as antibiotics, free of charge to all Australians. It wasn't until four years later, in 1948, under Labor Prime Minister Chifley, that a limited version of what we now know as the Pharmaceutical Benefits Scheme began, offering free medicines for pensioners, and 139 life-saving and disease-preventing medicines free of charge for the general public. In 1986, the Hawke Labor government introduced a safety net threshold of 25 prescriptions in a calendar year for both concessional and general beneficiaries, which meant, for the chronically ill and other high-volume users of prescription medicines, that no individual or family would have to pay for more than 25 PBS prescription items in any calendar year. Fast-forward to 2019, and medicines are now the most common medical intervention in health care in Australia. In fact, over 80 per cent of Australians aged 65 and over, and 70 per cent of Australians aged 45 to 64, regularly use pharmaceuticals.

While we support this bill, we know that this bill won't fix the crisis in medicines' affordability that we see on this government's watch. The government's own figures show that many Australians don't fill prescriptions because they just can't afford them. According to the Australian Bureau of Statistics, 961,000 people a year delay or avoid taking prescribed medicines due to cost. Alarmingly, the rate of people skipping prescriptions is twice as high in the most disadvantaged areas as in the least disadvantaged areas, meaning that the cost of medicines is contributing to healthcare inequality in Australia and to worse health outcomes for those in more disadvantaged communities.

For many years, I was a specialist mental health pharmacist and chief pharmacist at Wyong hospital in my electorate on the New South Wales Central Coast, and I note that this month we're marking Mental Health Month. The minister can spruik listing PBS drugs, but if people can't afford them then some will delay or avoid filling a prescription—particularly the most vulnerable in our communities, such as those living with major mental health conditions.

I've been there in an outpatient clinic when a patient living with a major mental health condition has said to me, 'Which medication can I do without?' These are real people with major health concerns who need proper support, and they are having to make this decision which no-one should have to make: 'Which one can I skip? Which one can I delay?' People are sometimes taking medications every second day, or they might get one prescription filled this month and an alternative prescription filled next month. And we know what happens when people skip their medications. They get worse, not better. They present at our emergency departments with worse symptoms and need urgent care and often lengthy inpatient stays, particularly patients living with chronic diseases and major mental health conditions.

Last week, I visited the St Vincent de Paul in Wyong in my electorate, where my late father, Grant, was a volunteer. It was, for me, a chance to hear from them of the work that they do to assist many people in our community, particularly people in crisis. This year, to date, they have assisted 108 people with health care, including prescriptions. Whilst I am grateful, and it's commendable that organisations like the St Vincent de Paul Society and other charities and not-for-profit groups provide assistance and sometimes vouchers for medication for people in crisis who can't afford to have their prescriptions filled, this should not happen in a wealthy country like Australia.

And what has this third-term government done about this crisis? It's only made it worse. In the 2014 budget, the government proposed to increase the cost of PBS medicines by up to $5—even for concession patients; even for age pensioners—and to increase the threshold for the PBS Safety Net, which, as I mentioned earlier, was introduced to help people, particularly those living with chronic, complex conditions and families, to be able to afford medicines. This would have forced patients to pay $1.3 billion more for medicines and caused even more Australians to skip essential treatment. It was only Labor's opposition in the parliament that stopped the government from implementing this cruel measure. But Australians shouldn't forget that this Prime Minister and this minister were part of a cabinet that wanted to make medicines more expensive for every Australian, including vulnerable Australians, such as age pensioners, and that measure was on top of the government's appalling record of delaying PBS listings.

Last month, the PBAC made public their recommendations from the July meeting, which took the total number of drugs waiting to be listed by Minister Hunt to more than 60. These are drugs that have been recommended for listing by independent experts, the Pharmaceutical Benefits Advisory Committee, because they stack up on both clinical and costs grounds. This includes medications like Symdeko, which was approved in March by PBAC.

Symdeko is a life-changing cystic fibrosis drug which treats the most common cystic fibrosis mutation, extending life expectancy and improving quality of life. The minister made a promise to those with cystic fibrosis that they would have access to Symdeko on the PBS as soon as it was approved. Thankfully, it appears there is now some movement on this, with the government shamed into reaching out to the manufacturer following a Channel Nine news report. It shouldn't take a news report for the government to do the right thing and to do what the minister said they would do. I would like to quote from a letter from Nettie Burke, CEO of Cystic Fibrosis Australia. This is how she described the delay: 'Seven months of lung damage, seven months of mental stress and strain, seven months of a blame game, seven months of the best hopes and the worst fears exacerbated—years of hope dashed by seven months.' Nobody should be put in that situation.

We shouldn't be surprised, really. The government has form when it comes to delays like this. In a press conference in November last year, Minister Hunt confirmed that Flash technology would be available on the National Diabetes Services Scheme on 1 March 2019, stating:

… as of the first of March 2019 the continuous glucose monitoring program will be expanded both in terms of the range of people but also in terms of the options for devices. The Flash glucose monitoring will now also be included alongside the Continuous Glucose Monitoring.

Seven months later, there is still no word.

This government has made 120,000 people living with diabetes type 1 wait seven months longer than he promised they would. That's a significant amount of time for someone living with type 1 diabetes, because of the long-term consequences that can happen from poorly managed or mismanaged diabetes. The health minister likes to congratulate himself. He often likes to come into the chamber and appear in the media and pat himself on the back with every PBS listing. He is also accountable for every drug that he refuses to list, for those almost 60 drugs that we know that PBAC has recommended and that haven't yet been listed on the Pharmaceutical Benefits Scheme.

Australians who are sick deserve to have a medication which has been approved by the PBAC recommended as soon as possible. The government's recent budget updates show an underspend of $155 million on the PBS. We know there are people living with chronic complex diseases, we know there are people in crisis, and we know there are vulnerable people, particularly First Nations peoples or people living with major mental health problems, who can't access these medications. We know that there are people who are in crisis or who are in urgent situations and can't get the essential health care they need. We know this particularly affects people in regional and remote Australia. We know that people in regional and remote Australia have worse health outcomes than those living in major cities. This is something that the government either hasn't recognised or hasn't properly acted to fix.

The government shouldn't be propping up its budget surplus by underspending on the Pharmaceutical Benefits Scheme. This government does like to pat itself on the back about having a budget surplus, but the reality is that the surplus is built on underspends like this one, and like the $4.6 billion underspend on the National Disability Insurance Scheme. These underspends are arising because of maladministration by this government, preventing Australians—particularly vulnerable Australians, many of whom live in rural and remote Australia—from accessing the essential services that they so desperately need and that a government should provide.

The latest health spending data from the Australian Institute of Health and Welfare show that out-of-pocket costs are the highest they have ever been, with Australians spending a record $30 billion a year for their own out-of-pocket costs for health care. This is an increase of $920 million over the financial year—up three per cent. So while this government spends less on the PBS, Australians are spending more, particularly those who can least afford it. Out-of-pocket costs have never been higher and hospital waiting lists have never been longer than under the Morrison government. They need to stop the delays on PBS listings and start treating Australian patients with respect.

I mentioned at the beginning of my remarks that I first registered as a pharmacist in 1998 and I worked for almost 10 years at my local hospital in Wyong, on the Central Coast of New South Wales, as a specialist mental health pharmacist and as a chief pharmacist. I have seen people in crisis, particularly families and those who are desperate, have to come to an emergency department because they can't get in to a GP or they can't afford the gap payment. All of that compounds. They might be able to get in to see a GP—and often with families it's not just one child who is sick; there will be more than one child sick at the one time—and then they might end up with three prescriptions for antibiotics that they have to fill at the community pharmacy. It is very expensive for families to be able to get the essential health care they need. For this government to be propping up its budget surplus at the expense of Australians, particularly vulnerable Australians—many of whom are living in regional and remote Australia—is not fair. The government needs to act. It needs to properly acknowledge the crisis. It needs to act in the interests of all Australians.

As I mentioned earlier, October is mental health month. Last week we marked headspace day and we also marked 10/10 World Mental Health Day. I want to speak to each of those as a former mental health worker. The government's appointment of Christine Morgan as a special adviser to the Prime Minister on suicide prevention is commendable. The government's commitments in the election to increasing funding, particularly to services for young people through headspace or other programs, is commendable. But what we really need to see is real action and genuine bipartisanship in the area of mental health.

Before I conclude, I would just like to go back to the visit that I had with St Vincent de Paul last week. As grateful as people are for the support of charities and organisations like St Vincent de Paul, it shouldn't be their responsibility to provide support for people to access essential health care. Over 100 people in this calendar year have already needed to access help from the St Vincent de Paul service in Wyong, and those are just people seeking support with health care and pharmaceuticals. I've worked in community pharmacies, particularly in pharmacies that are open out of normal business hours, where people have come in who have had a voucher in order to have a prescription filled. That shouldn't happen. We shouldn't see people having to get vouchers from charities to be able to get the essential medicines that they need. It's not fair and it should not happen in a wealthy country like Australia.

Accordingly, I move:

That all words after 'That' be omitted and the amendment be circulated in my name with a view to substituting the following words:

"whilst not declining to give the bill a second reading, the House criticises the Government for:

(1) delaying Pharmaceutical Benefits Scheme listings; and

(2) trying to increase PBS co-payments for all Australians".

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